Inter-rater reliability of global assessment of functioning in a clinical setting

Four studies on the inter-rater reliability of a proposed Axis V version for DSM-IV and of the CGAS involving 162 child and adolescent patients and 20 clinicians showed moderate agreement (intraclass correlation: 0.53-0.66). This was comparable to previous versions of Axis V, but lower than that reported for the CGAS. More detailed description of anchor points did not increase reliability nor there were differences in agreement when rating current or previous functioning.

Juvenile obsessive-compulsive disorder

OBJECTIVE

To describe the characteristics of a series of children and adolescents with obsessive-compulsive disorder (OCD) and evaluate the outcome of treatment.

METHOD

Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment.

RESULTS

Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome.

CONCLUSIONS

Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive-behaviour therapy alone.

Three-year outcome of disruptive adolescents treated in a day program

Adolescents (N = 38) who attended a multi modal day program were matched with a control group (N = 35) for age, gender, year of assessment, and on delinquent and aggressive scores. Parent and child were separately interviewed three years after initial assessment. Adolescents who attended the program functioned better overall and were more satisfied with treatment than controls. Both groups showed a poor outcome and a decrease in symptom scores. A diagnosis of conduct disorder, high delinquency scores and high total problem scores predicted a poorer outcome.

Reestablishment of the Smile after Hypoglossal-Facial Nerve Transfer: What Can We Learn?

Objective  The aim of this study was to assess the ability to smile following a hypoglossal-facial nerve transfer (N12-N7). Design  This is a retrospective chart review. Setting  National tertiary referral center for skull base pathology. Participants  Seventeen patients. Main Outcome Measures  The ability to smile following an N12-N7 transfer was assessed by five medical doctors on photographs of the whole face and frontal, orbital, and oral segments. The (segmented) photographs were scored for the symmetry, asymmetry, and correct or incorrect assessment of the affected side. Results  Seventeen patients were analyzed by 5 assessors providing 85 assessments. The whole face at rest was judged symmetrical in 26% of the cases and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20, and 35%, respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15, and 6%, respectively. The affected side of the frontal, orbital, and buccal facial segments during smiling was correctly identified in 89, 89, and 96%, respectively. Interobserver variability with Fleiss' kappa analysis showed that the strength of the agreement during smile of the total face was good (0.771) Conclusion  Following an N12-N7 transfer, a good facial symmetry at rest can be achieved. During smiling, almost all patients showed asymmetry of the face, which was predominantly determined by the orbital and oral segments. To improve the ability to smile after an N12-N7 transfer, additional procedures are needed.

Utah Young Adults Describe What They Wished They Had Learned in Sex Education: A Qualitative Study

Utah implements an abstinence-based approach to sex education. However, research has found that abstinence-based sex education is associated with higher risk-taking behaviors, and youth would like more from their school-based sex education. This study examined what sex education information or programs young adults in Utah would have liked to receive during high school. Participants provided responses to a single open-ended question included in the Utah College Sexual Behavior Survey. The results of a thematic analysis show the emergence of four salient themes, including fundamental knowledge, contraception and sexually transmitted infection prevention, personal safety, consent, and abuse. Findings suggest that participants wanted sex education beyond just abstinence and stressed the importance of inclusive education. Recommendations for school nurses and the important role they play in delivering sex education include receiving education needed to teach sex education and working with school health educators to act as a resource.

Reducing fracture incidence in children with osteogenesis imperfecta: contribution of orthotics to bisphosphonates treatment

PURPOSE

To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses.

OBJECTIVE

Was there an additional reduction in fracture incidence amongst children with Osteogenesis Imperfecta (OI) treated with both bisphosphonates and Hip-Knee-Ankle-Foot-Orthosis (HKAFO)?

MATERIALS AND METHODS

Of the 129 OI patients treated from 1990 to 2017, retrospective data from 48 patients who participated in the bisphosphonates-orthosis regime were analyzed including the incidence of fractures and modalities of fracture treatment.

RESULTS

Bisphosphonates usage was more frequent than bracing and there were more positive changes (smaller or equal number of fractures each year) than negative changes (more fractures each year); negative changes were scarce, explained by non-compliance with the use of bracing. Poisson regression models were significant for positive changes, whereas the interaction between them was borderline significant. The main finding is that the association between bisphosphonates usage and the number of positive changes was stronger among the patients who used braces more frequently and weaker among patients who used bracing less frequently.

CONCLUSIONS

Bracing of OI patients has an additive effect on bisphosphonate treatment in fracture prevention which should lead to the reconsideration of a hybrid approach to OI management.